Critical Role of Antidotes in Managing Toxicological Emergencies: Historical Evolution, Categorization, and the Importance of Antidote Banking - A Review of Literature.

Poisoning represents a significant and growing public health concern, as evidenced by the data from the National Crime Records Bureau indicating that poisoning accounted for 25.1% of the 164,033 reported suicides in 2021, with an additional 0.4% related to the ingestion of sleeping pills. This highlights the urgent need for effective antidotes in the management of toxicological emergencies. Antidotes, defined as therapeutic agents that counteract the effects of poisons, drugs, or toxins, play a critical role in toxicology. Their mechanisms of action include altering toxicokinetics, halting absorption, neutralizing toxins, or inhibiting harmful metabolic conversions. This review delves into the historical development of antidotes, their categorization, recommended dosages, indications, contraindications, and potential side effects. It also explores the concept of antidote banking, a strategic approach to ensure the availability of antidotes during emergencies. Understanding these aspects is vital for healthcare professionals in managing acute, unintentional, or self-poisoning cases effectively, especially among young adults. The historical evolution from Mithridatism, the first known antidote, to modern, evidence-based antidotes demonstrates significant advancements in medical science. Antidotes are categorized based on their mechanisms, including toxic effect bypass, inert complex formation, accelerated detoxification, reduced toxic conversion, receptor site blockade, and receptor site competition. In addition, they are classified by their site of action: serological, pharmacological, mechanical, physical, and chemical. Antidote banking, endorsed by the World Health Organization, emphasizes the need for a reliable supply of critical, emergency, and urgent antidotes to manage poisoning incidents efficiently. This comprehensive review provides valuable insights into antidote development and application, contributing to enhanced public health responses to toxicological emergencies.